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Incidence and management of dialysis patients with renal calculi
Rosalia Viterbo1, Jack H Mydlo
1Department of Urology, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Insights
Dialysis patients can develop kidney stones, with 5-13% experiencing symptomatic stones and high recurrence rates. Management includes monitoring, supplements, and watchful waiting for spontaneous passage, with advanced treatments available.
Area of Science:
- Nephrology
- Urology
Background:
- Renal stone disease presents a clinical challenge in dialysis patients, despite lower overall incidence compared to the general population.
- Understanding the unique aspects of stone formation and management in this cohort is crucial.
Purpose of the Study:
- To evaluate the incidence and management strategies for renal stone disease specifically in patients undergoing hemodialysis and peritoneal dialysis.
Main Methods:
- A comprehensive literature review was conducted using Medline, covering studies from 1966 to the present.
- Inclusion criteria focused on the detection and treatment of kidney stones in both hemodialysis and peritoneal dialysis patients.
Main Results:
- An estimated 5-13% of dialysis patients develop symptomatic renal calculi, with a significant proportion experiencing recurrent stone disease (up to 83.3% in one study).
- Asymptomatic calculi are also prevalent in this population.
Conclusions:
- Clinicians should maintain a high index of suspicion for stone formation in dialysis patients due to variable urine output.
- Recommendations include annual ultrasounds, citrate and magnesium supplementation, and monitoring of laboratory results. Careful follow-up of patients on aluminum-hydroxide phosphate binders is advised due to predisposition to Al-Mg-urate stones.
- Watchful waiting and symptomatic treatment are generally recommended for renal calculi, as spontaneous passage is common. Extracorporeal shock wave lithotripsy (ESWL) and other modalities can be used with comparable morbidity. Bilateral nephrectomies may be considered for severe, intractable cases in renal transplant candidates.
Objective:
The incidence of renal stones in patients on dialysis, while lower in number compared to the general population because of decreased renal function, is nonetheless a clinical dilemma. We wanted to evaluate the incidence and management of stone disease in patients on hemodialysis.
Methods:
We reviewed the literature from 1966 to the present using Medline. Study inclusion criteria were detection and treatment of stone disease in both hemodialysis and peritoneal dialysis patients.
Results:
It is estimated that between 5 and 13% of all dialysis patients will develop symptomatic renal calculi and many more asymptomatic calculi. Many of the stone-forming dialysis patients will have recurring stone disease with one study finding an 83.3% recurrence rate.
Conclusion:
Since dialysis patients have a wide range of urine output, the clinician should be alert to the possibility of stone formation. We recommend yearly ultrasound examinations on all dialysis patients as well as citrate and magnesium supplements with careful follow-up of laboratory results and urine electrolytes. We also recommend careful follow-up of all patients on aluminum-hydroxide phosphate binders as they are predisposed to form Al-Mg-urate stones. For those dialysis patients that form renal calculi, watchful waiting and symptomatic treatment is recommended since almost all patients will spontaneously pass their stones. However, ESWL and other current modalities may be used with no greater morbidity compared to nondialysis cohorts. We also suggest that patients with severe recurring intractable stone disease who are candidates for renal transplantation should be offered bilateral nephrectomies.
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